Failure to Ensure That All Residents Remain Free from Drugs That Cause Physical Restraint Unless Approved and Required for Medical Treatment

In a summary statement of deficiencies dated 07/01/2015, a complaint investigation was opened against the facility for its failure to “ensure residents were free from chemical restraints. Staff administered psychoactive medications to two residents [at the facility] who did not exhibit medical symptoms that warranted the use of the medication.”

An investigation into a complaint included a review of a resident’s Quarterly MDS (Minimum Data Set) revealing that the resident has “moderately impaired cognitive skills for daily decision-making, does not exhibit any physical or verbal behavioral symptoms directed toward other; rejecting care on 1 to 3 days during the assessment., Received antipsychotic medication seven days out of the last seven days […and] received antidepressant medications seven days out of the last seven days.”

The state investigator also reviewed the resident’s 04/16/2015 Comprehensive Plan of Care that instructed the staff to “reassure and console the resident as allowed encourage the resident to vent feelings as needed.” The staff was also directed to allow the resident “choices in care as able to safely make” and not to “argue with the resident when [they] are agitated.

The Plan of Care also guides the staff to “explain to the resident when behavior is an appropriate and disruptive to others […and] observer stressors that agitate the resident and remove as able […and] encourage group and diversional activities of interest […and] administer medications as ordered […and] removed from public areas for short periods only if disruptive/abusive to others and not easily redirected.”

The state investigator noted that the resident’s Comprehensive Plan of Care did not provide instruction as to when to administer the resident’s medications as needed.

The investigator also reviewed the resident’s 04/29/2015 Nurse’s Notes that revealed that staff members “documented administer the resident’s medications due to the resident screaming because [they] wanted to see the money lady (the person in the facility who manages the resident’s funds). The staff did not document the reason the resident could not talk to the staff member requested, nor did they document non-pharmacological interventions used to call the resident before they administered the [medication to calm the resident down].”

When the state investigator reviewed the resident’s Behavior Management Record revealed there was no documentation of any information in regards to the resident’s behavior or any interventions attempted on that date of 04/29/2015.

The investigator then conducted a 9:30 AM 07/01/2015 Interview with the Facility’s Assistant Director of Nurses who revealed that she was “not aware of the 04/29/2015 incident, but that the staff should have let the resident speak to the money lady.”

Our St. Louis nursing home abuse attorneys recognize that any failure to ensure that every resident remains free of all unnecessary drugs that may cause physical restraint has a potential of diminishing their quality of life. The deficient practice by the nursing staff at U-City Forest Manor might be considered abuse or mistreatment because they failed to provide access to persons in charge of the resident’s money after it was requested by the resident and failed to document why access was denied.

Failure to a Level of Care That Maintains or Enhances Every Resident’s Dignity and Respect of Individuality

In a summary statement of deficiencies dated 05/20/2015, a notation was made during an annual licensure and certification survey by a state investigator concerning the facility’s failure to “maintain resident’s dignity by reprimanding a resident and talking to a resident disrespectfully.” The deficient practice by the nursing staff at Bellefontaine Gardens Nursing and Rehabilitation Center affected one resident at the facility.

The deficient practice was noted by state surveyor after a review of a resident’s 01/12/2015 Quarterly MDS (Minimum Data Set) that documented the resident’s Brief Interview for Mental Status (BIMS) score of 15 out of 15 revealed that the resident is understood and is able to make themselves understood.

The state investigator reviewed a facility nurse’s Employee File that revealed an 11/04/2014 date of hire. In addition, the employee file revealed that the nurse had signed and dated a document listing the resident’s rights on 11/04/2014. This document revealed the resident has the right to communicate freely, participate in their care, and could refuse any treatment they do not want. In addition, the document notes that the resident has the right to exercise their rights, voice grievances and recommend changes to facility staff and is free of reprisal or discrimination.

The employee also signed a document noting that the resident has the right to be free from abuse and not subjected to emotional injury or harm.”

The state investigator documented that the employee’s Counseling Notices revealed that on 01/26/2015, the nurse “had a negative disposition and comments in the presence of residents and staff. Employees to conduct self and professional manner at all times.” An additional notation was made on February 20 15,015 that the nurse “failed to carry out general or specific instructions, [and failed] to perform job responsibilities, chart on a resident for 72 hours, applying treatment which had been discontinued and talking to a resident about other residents.”

An observation of the nurse was made at 7:59 AM on 05/15/2015 revealing that the nurse “interacted with [a resident] on the 100 Hall […and] said in an accusatory tone, ‘do you know you went with no oxygen all day yesterday?’ The resident responded in a defensive tone that [they] did not go without oxygen.” In response, the nurse raised their voice and told the resident they “did go without oxygen and [they] knew it because the resident left for dialysis [a treatment that filters toxins from the bloodstream given individuals that have poor or no kidney function] with a full tank of oxygen and returned with a full tank.”

During the verbal interaction, the nurse and the resident “continue to argue back and forth regarding who was right. The resident propelled [themselves] down the hall toward the nursing station, away from [the nurse in question] as the argument continued.” At that point, the nurse “then followed the resident down the hall and as [they] approached the resident said, ‘it is true!’.”

A few minutes later at 8:08 AM, interview and observation revealed that “the resident sat in [their] wheelchair at the nurses’ station […and] began to cry and said [the nurse] did not need to talk to [them] that way.”

The state investigator conducted an 8:23 AM 05/15/2015 interview with the facility’s Administrator who said that “this incident was not acceptable […and] staff should always treat residents with dignity and respect.” Inspector then conducted at 10:30 AM group interview that same morning involving two of five residents identified by the staff is alert and oriented [who] said they have heard staff yell at the resident and be rude to them.”

Three days later on 05/18/2015 at 1:30 PM, the state investigator conducted an interview with the facility’s Director of Nursing who “set the counseling notices [that verbally argumentative nurse] received were the only follow-up done. No further in-servicing was done in regards to the previous incidences because [that nurse] is a licensed nurse and knows what [they] did wrong.”

Our St. Louis nursing home abuse law firm recognizes that failing to provide every resident a level of care that enhances or maintains their dignity and right of individuality has the potential of diminishing their quality of daily life. The deficient practice by the nursing staff at Bellefontaine Gardens Nursing and Rehabilitation Center might be considered abuse or mistreatment because their actions fail to follow established policies, procedures and protocols enforced by federal and state nursing home regulators.

Failure to Ensure That Quality Lab Services and Tests Were Performed in a Timely Manner That Meet the Needs of the Residents

In a summary statement of deficiencies dated 01/28/2016, a notation was made by a state investigator during an annual licensure and certification survey concerning the facility’s failure to “ensure all laboratory tests were obtained as ordered by the physician.” The deficient practice by the nursing staff at the Estates of St. Louis affected one resident at the facility.

The deficient practice was noted by state surveyor after a review of a resident’s medical records that revealed a 12/01/2015 Physician’s Order “to obtain an ammonia level [blood test to measure the amount of ammonia in the blood – which can be harmful in high concentrations when protein is broken down by bacteria in the individual’s intestines. Additionally, ammonia levels found in the blood can rise anytime the liver is unable to convert ammonia into urea].”

The state investigator also noted there was a 12/10/2015 Physician’s Order “to recheck the ammonia level in one week” and another order on the same day “to obtain a Hemoglobin A1C [a 3-month average blood sugar level test] and ammonia level again on 12/21/2015. Another order for 12/29/2015 was noted by the physician “to obtain a urinalysis with culture and sensitivity [a test used to detect whether or not the resident has a urinary tract infection].”

The state investigator reviewed the resident’s laboratory test results that revealed that on 12/03/2015, the resident had an above ammonia level of 97, where the normal range is 19 – 87. Investigator knows that there are “no further ammonia levels obtained as late as 01/26/2016 […and] no Hemoglobin A1C […and] no urinalysis with culture and sensitivity results from 12/29/2015 through 01/26/2016.” The state investigator conducted a 10:10 AM 01/20/2016 interview with the facility’s Director of Nursing who said that “the lab was contacted and [the physician’s orders on testing] had not been done. The lab should have been done as ordered.”

Our St. Louis elder abuse lawyers recognize the failing to follow physician’s orders for testing could place the health of the resident in Immediate Jeopardy. The deficient practice of the nursing staff at the Estates of St. Louis might be considered negligence or mistreatment because their actions fail to follow established procedures and protocols enforced by federal and state nursing home regulations.

Failure to Ensure That Lab Services and Tests Were Performed in a Timely Manner That Meet the Needs of the Residents

In a summary statement of deficiencies dated 09/04/2015, a notation was made by a state investigator during an annual licensure and certification survey concerning the facility’s failure to “ensure laboratory tests were obtained as ordered for [four residents at the facility].”

The deficient practice was noted by state surveyor after a review of a resident’s medical records that revealed a variety of physician’s orders for laboratory tests to check the cholesterol level in the blood system of a resident. The investigator noted that under the laboratory section of the resident’s medical record did not show any test results as required on 08/20/2015. In addition, the resident’s 08/15/2015 through 09/14/2015 physician order sheet revealed that the facility was to perform yearly tests to check the resident’s cholesterol level. Although there were results obtained in regards to laboratory test “in May 2014, there were no results for 2015 […and] no results for a fasting lipid panel [cholesterol test] found or provided by the facility.”

The state investigator conducted a 12:25 PM 09/02/2015 interview with the facility’s Care Coordinator who called the laboratory and said that the 08/14/2015 testing was rejected and not done and that the laboratory “did not redraw the blood test as ordered.”

The investigator also reviewed the resident’s Quarterly MDS (Minimum Data Set) and July 15 through 08/14/2015 physician’s order sheets that call for a test to be done to detect blood and feces. However, as of 09/04/2015, no results for that test were provided or documented. During a 09/03/2015 1:10 PM interview with the Director of Nursing, it was revealed that the Director “expected nursing staff to follow all physician’s orders.”

Our St. Louis nursing home neglect law firm recognizes that failing to perform lab services and testing according to physician’s orders in a timely manner could place the health and well-being of the resident in danger. The deficient practice by the nursing staff at Heritage Care Center could be considered mistreatment or negligence because their actions fail to follow protocols and guidelines established by federal and state nursing home regulatory agencies.

Failure to Ensure That Every Resident Receives Services and Treatments That Not Only Continue but Improve Their Ability to Care for Themselves

In a summary statement of deficiencies dated 06/05/2015, a state surveyor made a notation during an annual licensure and certification survey concerning the facility’s failure to “perform restorative therapy (RT) as ordered by the physician for six [residents out of 137 residents at the facility].”

The deficient practice was noted by state surveyor after review of a resident’s Quarterly MDS (Minimum Data Set) that revealed that the resident “has severely impaired cognition and requires total assistance, from staff for bed mobility, transfers, dressing, eating, hygiene and bathing.” In addition, the documentation revealed that the resident has “impaired range of motion affected one side of the body on the upper and lower extremities […and is] incontinent of bowel […and has an] indwelling urinary catheter” that is it to that is inserted into the resident’s bladder to drain urine.”

The surveyor also notes that the resident’s Quarterly MDS (Minimum Data Set) reveals that the resident is at “risk for development of pressure ulcers [and has] a Stage III pressure ulcer.” A Stage III pressure ulcers considered full thickness tissue loss where the subcutaneous fat is likely visible however muscle, bone and tendons are not yet exposed. These severe nearly life-threatening pressure ulcers may also involve dead tissue (slough), tunneling and undermining.

The state investigator also reviewed the resident’s physician order sheets throughout June 2015 that revealed a physician’s orders for “restorative therapy for bilateral upper extremity passive range of motion exercises and bilateral upper extremity elbow and hand splinting… five times a week.” The hand splinting device is to be worn in an effort to promote and increasing the range of motion and as a way to prevent contractures of the hand.

The investigator notes that the resident’s Restorative Notes show that the restorative therapy was performed on 12 different occasions throughout the month of May and again on 06/01/2015 and 06/04/2015. However, at 10:25 AM on 06/03/2015, and observation of the resident was made noted that they were lying “in bed without bilateral hand and elbow splints.” The following day at 7:00 AM on 06/04/2015, an interview and observation were made that showed that the resident was lying in bed during restorative therapy exercises using bilateral hand splints.

“The Restorative Aide said the resident should receive restorative therapy exercises and hand/elbow splinting five times a week, but usually received restorative therapy three times a week. The Restorative Aide said [that they are] responsible for providing the restorative therapy for the resident’s on this unit […and] said the resident’s elbow splints were missing and could not recall the exact date when they went missing.”

The investigator then conducted in a 20 5 AM 06/05/2015 interview with the facility’s Director of Nurses who said that “they have three Restorative Therapist and are looking for a fourth, but no one wants the position because they know it is a lot of work. She tries to help with the Restorative Therapists when scheduled off or are sick.”

Our Ferguson nursing home neglect attorneys recognize that failing to provide necessary services and treatment to residents in an effort to continue and enhance her ability to care for themselves could place their well-being in jeopardy. The deficient practice by the nursing staff at Christian Care Home might be considered negligence or mistreatment because their actions could likely diminish the resident’s ability to restore their health and range of motion.

Abuse and Neglect Attorneys in Missouri

Nursing facilities are legally bound to treat the disabled, elderly or infirmed with all the care, dignity and respect they deserve. However, often times the staff neglect their duties and allow residents to walk without assistance that could cause a fall, consume the wrong foods that could cause choking or failed to reposition the body of a mobility-challenged resident that could lead to a facility-acquired pressure sore.

In many cases, the nursing staff simply neglects the resident by leaving them unattended for hours at a time. Other times, the medication treatment nurse fails to give the resident their drugs on time, or at all. Many cases of abuse and neglect involve incidences where the resident was deprived of basic necessities including water, food, shelter, clothing, medicine, personal hygiene, personal safety, comfort and other needed services.

Unfortunately, the cases involving abuse have become a widespread epidemic in many nursing facilities. The National Center on Elder abuse says the most common forms of injury, abuse and neglect involve:

Physical punishment or assault

Sexual abuse

Improper medication used as a restraint

Unauthorized physical restraints including belts and straps

Poor hygiene

Unsanitary conditions

Bodily injury, impairment or pain

Inadequate or inappropriate medical care

Isolation, humiliation, intimidation, harassment or another form of emotional trauma

Dehydration or malnutrition

Resident to resident abuse

Falls caused by neglect, mistreatment or a lack of supervision

Psychological or emotional abuse

Force-feeding

Medical errors

Bedsores acquired at the facility after admission

Safety and health hazards

By law, nursing facilities are legally bound to provide every resident their dietary requirements, personal hygiene and medical needs in addition to maintaining their safety to ensure their protected from health hazards posed by staff members or environmental conditions. Sadly, many nursing facilities don’t do an adequate job of providing the highest level of care. As a result, the victim often suffers life-changing injuries, emotional trauma and, in some cases, death.

Claiming Financial Compensation

You and your family members likely have questions about every legal option to protect your loved one neglected, abused or harmed in a nursing facility. The St. Louis nursing home abuse attorneys at Rosenfeld Injury Lawyers LLC have your answers. Our team of dedicated Missouri elder abuse lawyers will fight aggressively for the right of your loved one against the nursing facility and any other responsible party at fault for causing harm.

We encourage you to contact our law offices today at (800) 926-7565 to schedule a no obligation, free full case review. All information you share with our law offices remains confidential. Like all personal injury and wrongful death lawsuits, we handle every nursing home abuse and mistreatment case through contingency fee arrangements. This means you receive immediate legal representation, counsel and advice without any payment of an upfront fee. We are only paid for our legal services once we negotiate an acceptable out of court settlement or win your case in front of the judge and jury.

For additional information on Missouri laws and information on nursing homes look here.

If you are looking for information on a specific facility or an attorney, please see links below to respective locality pages.

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After I read Jonathan’s Nursing Home Blog, I decided to hire him to look into my wife’s treatment at a local nursing home. Jonathan did a great job explaining the process and the laws that apply to nursing homes. I immediately felt at ease and was glad to have him on my side. Though the lawsuit process was at times frustrating, Jonathan reassured me, particularly at my deposition. I really felt like Jonathan cared about my wife’s best interests, and I think that came across to the lawyers for the nursing home. Eric